Provider Demographics
| NPI: | 1053616193 |
|---|---|
| Name: | THERAPLAY OF NORTH CAROLINA, PC |
| Entity type: | Organization |
| Organization Name: | THERAPLAY OF NORTH CAROLINA, PC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | AMY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PACE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 336-817-1893 |
| Mailing Address - Street 1: | PO BOX 111 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PINNACLE |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 27043-0111 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 336-817-1893 |
| Mailing Address - Fax: | 336-325-2335 |
| Practice Address - Street 1: | 1144 PACES PLACE ROAD |
| Practice Address - Street 2: | |
| Practice Address - City: | PINNACLE |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27043-0111 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 336-817-1893 |
| Practice Address - Fax: | 336-325-2335 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2011-01-21 |
| Last Update Date: | 2011-01-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 224Z00000X, 225100000X, 225200000X, 235Z00000X | ||
| NC | 4864 | 225XF0002X, 225XP0200X, 225X00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Single Specialty | |
| No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Single Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Single Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |
